Healthcare Provider Details

I. General information

NPI: 1609439942
Provider Name (Legal Business Name): KAMIYAMA PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BROADWAY CONCOURSE LEVEL
NEW YORK NY
10018
US

IV. Provider business mailing address

1 ORIENT WAY STE F217
RUTHERFORD NJ
07070
US

V. Phone/Fax

Practice location:
  • Phone: 201-655-9029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KENTO KAMIYAMA
Title or Position: OWNER
Credential:
Phone: 201-655-9029